Propranolol

Propanolol (brand names Bedranol, Beta-prograne, Half Beta-prograne) belongs to a group of medicines called beta blockers. It is used to treat heart problems, help with some of the symptoms of anxiety and prevent migraines.[1]

For heart problems, propranolol can be taken to to:[1]

Propranolol
Clinical data
Pronunciation/proʊˈprænəˌlɑːl/
Trade namesInderal, others
AHFS/Drugs.comMonograph
License data
Pregnancy
category
  • AU: C
Routes of
administration		Oral, rectal, intravenous
ATC code
Pharmacokinetic data
Bioavailability26%
Protein binding90%
MetabolismLiver (extensive) CYP1A2, CYP2D6; minor: CYP2C19, CYP3A4
MetabolitesN-desisopropylpropranolol, 4'-hydroxypropanolol
Elimination half-life4–5 hours
ExcretionKidney (<1%)
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
ECHA InfoCard100.007.618
Chemical and physical data
ChiralityRacemic mixture
  (verify)

This medicine can cause serious allergic reactions that require emergency treatment. Make sure the signs of these reactions are known: read allergic reaction symptoms of drugs.

Propranolol slows down the heart rate and makes it easier for the heart to pump blood around the body. Propranolol can also help reduce symptoms of having too much thyroid hormone in the body (thyrotoxicosis). Usually, it will be taken together with medicines to treat an overactive thyroid.[1]

Propranolol was patented in 1962 and approved for medical use in 1964.[2] It is on the World Health Organization's List of Essential Medicines.[3] Propranolol is available as a generic medication.[4] In 2021, it was the 91st most commonly prescribed medication in the United States, with more than 7 million prescriptions.[5][6]


Who can and cannot take propranolol

Most adults and children aged 12 and over can take propranolol. But it is not officially approved for treating high blood pressure in children under 12 years old.[1]

Propranolol is not suitable for everyone. To make sure it's safe, tell the doctor before starting if:[1]

  • there has ever been an allergic reaction to propranolol or any other medicine
  • there is low blood pressure or a slow heart rate
  • there is heart failure which is getting worse
  • have ever had depression or had thoughts about self harm
  • there is diabetes
  • there are liver or kidney problems
  • there are severe blood circulation problems in the limbs (such as Raynaud's phenomenon), which may make fingers and toes tingle or turn paler than usual or blue
  • there is metabolic acidosis, when there is too much acid in the blood
  • there is lung disease or asthma
  • are pregnant, trying to get pregnant or breastfeeding

Taking propanolol

This medicine is only available on prescription. It comes as tablets, slow release capsules, or as a liquid that is swallowed.[1]

Important: Keep taking propranolol even if you feel well. You will still be getting the benefits of the medicine.[1]

The very first dose of propranolol may make people feel dizzy, so it is taken at bedtime. After that, if the dizzy feeling does not happen, it can be taken in the morning.[1]

Propranolol comes as 2 different types of medicine:[1]

  • standard release – this releases propranolol into the body quickly, so it may need to be taken several times a day depending on the dose
  • slow release – this releases the medicine slowly so it does not have to be taken as often. Once a day is usually enough

If taking it once a day, then it is taken at bedtime the first time, as above. This is to see if it causes dizzy feeling.[1]

Dosage and strength

Propranolol tablets come in strengths of 10mg, 40mg, 80mg or 160mg. The slow release capsules are 80mg or 160mg. The liquid comes in strengths of 5mg, 10mg, 40mg or 50mg in 5ml.[1]

Dose depends on why propranolol is being taken. The usual doses for adults are:[1]

  • high blood pressure
    • the starting dose is usually 80mg, taken twice a day. If this dose is not working well enough to reduce blood pressure, the doctor may increase it to a maximum of 160mg twice a day
  • migraine or angina (chest pain)
    • 40mg, taken 2 or 3 times a day. This can be increased to 120mg to 240mg a day. The doctor or pharmacist will explain how to split the dose over the day
  • irregular heartbeat (arrhythmia)
    • 10mg to 40mg, taken 3 or 4 times a day
  • anxiety
    • 40mg taken once a day which can be increased to 40mg taken 3 times a day
  • too much thyroid hormone (thyrotoxicosis)
    • 10mg to 40mg, taken 3 or 4 times a day

Doses are usually lower for people aged over 65 or people with a kidney or liver problem[1]. If it is a child who needs propranolol, the doctor will usually use the child's weight to work out the right dose.[1]

How to take it

Propranolol does not usually cause upset stomach so it can be taken with or without food. It's best to do the same each day.[1]

Swallow the tablets whole with a drink of water. If swallowing tablets is difficult, some brands have a score line to help break the tablet in half. Check the information leaflet for the brand to see if this can be done with the specific tablet. If taking it as capsules, swallow them whole with a drink of water. Do not break, chew or crush them.[1]

When taking propranolol as a liquid, it will come with a plastic syringe or spoon to help measure out the right dose. If there is none, ask a pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount of medicine.[1]

Forgetting to take propanolol

If a dose of propranolol is missed or forgotten, take it as soon as it is remembered, unless it is nearly time for the next dose. In this case, just leave out the missed dose and take the next dose at the usual time.[1]

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.[1]

If forgetting doses often, it may help to set an alarm as a reminder. Also, ask a pharmacist for advice on other ways to help with remembering to take the medicine.[1]

Taking too much/overdose

An overdose of propranolol can be very serious. It can significantly slow heart rate, cause dizziness, trembling and seizures or fits, and make it difficult to breathe.[1]

The amount of propranolol that can lead to an overdose varies from person to person. If too much is taken, see a doctor or call non-emergency services.[1]

If going to A&E, do not drive. Get someone else to drive, or call for an ambulance. Take the propranolol packet or leaflet inside it plus any remaining medicine with you.[1]

Go to A&E or call emergency services if more than the prescribed dose of propranolol is taken and any of the listed problems occur:[1]

  • a slow heart rate
  • breathing problems
  • feeling dizzy or shaky
  • have any seizure or fits

Side effects

These are not all the side effects of propranolol. For a full list, see the leaflet inside the medicine packet. Like all medicines, propranolol can cause side effects in some people, but many people have no side effects or only minor ones. But side effects often improve as the body gets used to the medicine.[1]

Common side effects

These common side effects happen in more than 1 in 100 people. They're usually mild and short-lived.[1]

Talk to the doctor or pharmacist if the side effects are a bother or last more than a few days:[1]

  • headaches
  • feeling tired, dizzy or weak
  • cold fingers or toes
  • feeling or being sick (nausea or vomiting), or diarrhoea
  • stomach pain

Serious side effects

It happens rarely, but some people have serious side effects when taking propranolol.[1]

Tell a doctor or call non-emergency services straight away if:[1]

  • the whites of the eyes turn yellow, skin turns yellow (although this may be less obvious on brown on black skin), or poo is pale, or dark pee – these can be signs of liver problems
  • nosebleeds that last for more than 10 minutes, unexplained bruising, or bruising more easily than usual – these can be signs of low numbers of platelets in the blood (thrombocytopenia)

Call an ambulance for the following side effects:[1]

  • shortness of breath with a cough which gets worse with exercise (like walking up stairs), swollen ankles or legs, chest pain, or an irregular heartbeat – these are signs of heart problems
  • shortness of breath, wheezing and tightening of the chest – these can be signs of lung problems

Serious allergic reaction

In rare cases, propranolol may cause a serious allergic reaction (anaphylaxis).[1]

How to cope with side effects of propranolol[1]

What to do about:

  • headaches
    • make sure rest and drink plenty of fluids. Try not to drink too much alcohol. Ask a pharmacist to recommend a painkiller. Talk to the doctor if the headaches last longer than a week or are severe.
  • feeling tired, dizzy or weak
    • as the body gets used to propranolol, these side effects should wear off. If propranolol causes a dizzy feeling, sit or lie down till feeling better and the side effect goes. It's best not to drink alcohol as it will make the feelings worse. Do not drive or ride a bike until feeling better.
  • cold fingers or toes
    • put cold hands or feet under warm running water, massage them and wiggle the fingers and toes. Do not smoke or have drinks with caffeine in, as this can make blood vessels narrower and further restrict blood flow to the hands and feet. Try wearing mittens (they are warmer than gloves) and warm socks. Do not wear tight watches or bracelets.
  • feeling or being sick or diarrhoea
    • stick to simple meals and do not eat rich or spicy food. It might help to take propranolol after a meal or snack. Drink lots of fluids, such as water or squash, to avoid dehydration. Take small, frequent sips if vomiting (beinng sick). Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea and vomiting without speaking to a pharmacist or doctor. If taking the combined contraceptive pill or progestogen-only pill and this medicine is causing sickness, or severe diarrhoea for more than 24 hours, the contraception may not be work to protect from pregnancy. Check the pill packet for advice.
  • stomach pain
    • try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on the stomach may also help. If there is a lot of pain, speak to a pharmacist or doctor.

Pregnancy

Propranolol is not thought to be harmful during pregnancy, but it may affect baby's growth in later pregnancy. Discuss taking propranolol with the doctor or midwife as extra scans may be needed to check the baby's growth.[1]

If trying to get pregnant or already pregnant whilst taking the drug, talk to a doctor about the benefits and possible harms of taking propranolol. There may be other medicines that are better to use during pregnancy.[1]

Breastfeeding

If a doctor or health visitor says that baby is healthy, it's OK to take propranolol while breastfeeding.[1]

Propranolol passes into breast milk in tiny amounts. It has not been known to cause any side effects in breastfed babies.[1]

It's important to treat high blood pressure to keep the mother well. Breastfeeding will also benefit both mother and baby. However, if noticing that baby is not feeding as well as usual, or seems unusually sleepy, or if there are any other concerns about baby, then talk to the doctor or health visitor[1]

Cautions with other medicines

There are some medicines that may affect the way propranolol works.[1]

Tell the doctor if the following medications are being taken:[1]

  • other medicines for high blood pressure. The combination with propranolol can sometimes lower the blood pressure too much. This may make cause dizzy or faint feelings. If this keeps happening, the doctor may change the dose
  • other medicines for an irregular heartbeat such as amiodarone or flecainide
  • other medicines which can lower blood pressure. These include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or Parkinson's disease medicines such as levodopa
  • asthma or chronic obstructive pulmonary disease (COPD) medicines
  • diabetes medicines, particularly insulin – propranolol may make it more difficult to recognise the warning signs of low blood sugar. Speak to a doctor if sometimes low blood sugar levels happen without getting any of the usual warning signs. Check blood sugar after exercise, and follow usual advice about checking it before driving, cycling or operating machinery
  • medicines to treat nose or sinus congestion, or other cold remedies (including those which can be purchased in the pharmacy)
  • medicines for allergies, such as ephedrine, noradrenaline or adrenaline
  • non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac or naproxen. These medicines may increase blood pressure, so it's best to keep them to a minimum

Mixing propranolol with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements with propranolol. They are not tested in the same way as pharmacy and prescription medicines.[1]

References
  1. "Propranolol: medicine for heart problems, anxiety and migraine". nhs.uk. 2019-01-14. Retrieved 2024-06-04.
  2. Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 460. ISBN 9783527607495.
  3. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  5. "The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.
  6. "Propranolol - Drug Usage Statistics". ClinCalc. Retrieved 14 January 2024.
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